Dementia: Communication, hard-to-manage behaviours and safety A much needed re-framing of Dementia from Alberta Health Services clinical nurse specialists, Jennette Coats and Loralee Fox, who embrace care and caring for those with ‘broken brains’. I sat in on their extremely practical and sensitive strategy session for supervisors of Home-Care Workers organized by Revera Health Care.Whose patient population increasingly has one or more Dementia: Alzheimer’s, Lewy Body, Fronto-Temporal Lobe, Vascular Attendees included nurses, occupational therapists, social workers, personal support workers and physiotherapists who shared some of their own coping stories, dealing with their own parents with Dementia: “I could tell my mom all the awful stuff about my divorce. She’d forget as soon as I told her – so I got to ‘dump’ without guilt.” As the broken brain description implies, it’s more than just memory loss that caregivers cope with. It’s the responsive b behaviors – aggression, anxiety, agitation, wandering – that drains emotionally and physically. One of the strongest messages acknowledged the issue of time: Caring for someone with violent behaviours of dementia can take 50% more time Staying safe takes time: trying to be efficient can be self-defeating “Rushing through can cause emotional distress and increase anxiety, agitation, and aggression.” From the Gerio Psychiatric Education program in Victoria British Columbia, the acronym, ABCDE Apologies: One of the most powerful the calming strategies I’m sorry – I didn’t mean to upset you. I’m sorry – you’re right. I’m sorry I made you feel (angry, hurt, dismissed..) I’m sorry – I know you’re trying so hard. I’m sorry – this must be so hard for you. One of the...

In a word: Yep. Our skin thins and gets dry Thin, dry skin often gets itchy. And that can lead to a mess of problems. Hence, the expression: thin-skinned. Perhaps not as talked about as the other issues of aging, but should be – considering how much skin we have. Dr Richard Usatine my fellow Society of Teachers of Family Medicine (STFM) is a primary care doc and lead author of The Color Atlas of Family Medicine. A lesson in elder-skincare “Our glands produce less natural oil which leads to dry skin. We scratch and we pick and broken skin can lead to infections. often the backs of our hands and forearms that are first affected.” In addition to the natural aging process, there are factors that influence the thinning of the skin: genetics, lifestyle specifically sun exposure, smoking and alcohol, and some medications can make skin more sensitive. What to do to protect our skin? The good doc offers these tips: Gloves: for gardening, biking, cleaning. Moisturize: doesn’t have to be expensive product. Good time to moisturize is after a bath or shower – which should not be too hot. Gentle cleaning, proper drying and staying dry – including sweaty parts like armpits, folds of skin, groin – can help prevent skin break-down. Keep hydrated: drink more water. Alcohol doesn’t count. Eat properly: good nutrition helps in so many ways Wear a hat: The tops of our heads also need care: skin thins there, too. Use sunscreen and stay out of the sun, especially between those hottest hours 11 – 3pm. Feet: a high-risk area – as those...

To restrain or not to restrain Until I met Sylvia Davidson, the word restraints scared the bejesus out of me, conjuring up straight jackets, handcuffs, ropes tape over mouth and struggling terrified restrainees. (clearly, I’m watching too many crime shows). That was B-S: Before Sylvia – Advanced Practice Leader, Geriatrics at Toronto Rehab and past President Ontario PsychoGeriatric Association. In Sylvia, I found a woman whose first concern is what’s best for the patient. Considering her patient population has dementia, gaining an understanding of the patient, to determine what’s best for them, is not all that dissimilar to a crime investigation – where the goal is to gain trust towards getting the truth. More than technical skills, this requires an emotional connection. “Nurses here are schooled in the 3 D’s: Delirium, Depression, Dementia. It’s our job to figure out who and how he/she was before dementia.” The Restraints Minimization Act describes when they are to be used: “for the prevention of serious bodily harm to a patient or to others”. There are three categories of restraints: Chemical Environmental Physical Before restraints of any kind are considered, there has to be consent – usually from the surrogate/substitute decision-maker, who is made aware of risks and benefits, a couple of examples of which are: Benefits: facilitating activities, calming and preventing harm. Risks: becoming more agitated, not being able to get to the bathroom (incontinence), being more unsteady afterwards. With consent, a comprehensive assessment process – with the family and the patient at its center. “Family members are so important because they knew this person before dementia set in. If we learn...

Dealing with grief and End of Life as a Personal Support Worker Guest Post by Natrice Rese It’s something that you are prepared for as a student. It is understood that as a caregiver, a PSW, you will maintain a distance, a separation, a formal kind of relationship with your clients and residents. But when you actually begin the job you quickly find out that it is not quite as easy to deal with when you can put faces, names and personalities to the residents you care for. Close connections bring an affection for your clients and vice versa. Personally I found it hard to be at a distance: When you give total and personal support to residents you can’t help but have feelings of friendship, protection, and empathy that is by nature what a caregiver has in his or her “toolbag”. I recall one particular lovely lady who was often in my care in the facility where I worked. I will call her “Mary”. Mary had brilliant silver hair and very blue eyes, lots of smiles, laughs and mischievous looks. She was obviously loved by her family and had visits often. Mary was dealing with many issues: she endured a stroke that limited her movement and mobility. She also had dementia so she needed a lot of support, smiles, hugs, and conversation. Although Mary was confined to a wheelchair she was able to roll her chair around the halls and with one hand surprisingly strong. She was as continually busy as a small child is, always on the move, always into something – often trying to exit through doors, enter...

Personal Support Workers (PSWs) Rock and Rule Anyone who’s needed practical help with daily living when in a health situation knows that it’s not the doctor or nurse you turn to or rely on. Whether at home, or in a health facility, the day to day care delivery falls to the Personal Support Worker. In a workshop organized by the Ontario Long Term Care Association focusing on Palliaitve Care in Long Term Care – with the theme: Care for Life, I sat amongst a packed room-full of (mostly) women PSWs. Their satisfaction comes not from having the latest medical intervention, or cutting edge equipment but rather from spending more time with their ‘residents’ than any other healthcare professional – which means knowing the small pains and pleasures better than anyone – often more than family members. I tweeted to the world: Day-to-day efforts may seem thankless work but for the PSW this goes with job satisfaction: In Palliative care – with its emphasis on whole person comfort and whole person symptom management – these PSWs have learned to read their residents non-verbal language: often a factor in those with Dementia. PSWs form such lasting relationships with residents and their families that they often attend the funeral and keep in touch after a residents’ death.I wonder, with so many who are in their care at life’s end, how do they cope with deaths – do they call upon social workers, chaplains or bereavement counselors? The resounding answer is: “We get comfort from our colleagues – fellow PSWs: only another PSW can understand the relationship and loss.“ I was shocked...